Table 2 Major themes, comparisons pre- and post-release, and relevant theoretical constructs
Major themes | |||
|---|---|---|---|
Domain | Pre-release | Post-release | Theoretical construct |
Individual and environmental determinants | â—Ź Substance misuse was viewed as a pervasive, negative influence which led to ART non-adherence, poor health, fractured family networks, and incarceration. | â—Ź Substance misuse continued to be a pervasive, negative influence which led to non-adherence, poor health, and fractured social networks, and incarceration. | â—Ź SCT, Individual Determinants, Environmental Determinants, Reciprocal Determinism |
â—Ź Participants were keenly aware of risk of substance misuse relapse and its association with poor HIV management, but unsure how to avoid relapse. | â—Ź Participants were keenly aware of risk of substance misuse relapse and its association with poor HIV management, but many were unable to avoid relapse. | â—Ź SCT, Self-Regulation/Self-Monitoring | |
â—Ź Challenges with housing, stressful life circumstances, and meeting daily needs led to relapse. | â—Ź SCT, Reciprocal Determinism | ||
â—Ź Substance use led to ART non-adherence, poor health, and criminal behavior. | â—Ź SCT, Reciprocal Determinism | ||
â—Ź Participants desired to avoid past peer networks and to develop new, positive social networks. | â—Ź Participants varied in their abilities to develop positive social networks and to reconnect with family members. | â—Ź SCT, Self-Regulation/Enlistment of Social Support | |
â—Ź Peer networks were associated with substance use and criminal behavior. | â—Ź Participants who reconnected with past peer networks relapsed and returned to criminal behaviors. | â—Ź SCT, Reciprocal Determinism | |
â—Ź Family networks were strained due to substance use, criminal behavior, or HIV status. | â—Ź Participants who developed new social networks (e.g., church groups) or reconnected with family avoided substance misuse. | â—Ź SCT, Reciprocal Determinism, Self-Regulation/Enlistment of Social Support | |
â—Ź Social networks had unanticipated positive role in HIV management (e.g., transportation to appointments, medication reminders, help completing paperwork and securing benefits. | â—Ź SCT, Reciprocal Determinism, Self-Regulation/Enlistment of Social Support | ||
HIV management | â—Ź Participants viewed HIV management as an important part of staying healthy and motivation to avoid substance misuse. | â—Ź Participants viewed HIV management as an important part of staying healthy, but HIV care was often eclipsed by substance misuse. | â—Ź SCT, Outcome Expectations |
â—Ź Participants expressed confidence in their ability to adhere to ART and to manage their HIV. | â—Ź Many participants described periods of ART non-adherence and poor health, largely due to substance misuse relapse. | â—Ź SCT, Self-Efficacy | |
â—Ź Participants who had been diagnosed with HIV during previous incarcerations felt they could easily find a doctor, but were worried about paying for medications if they could not find a job. | â—Ź Challenges finding employment and meeting basic needs were greater than anticipated. Many participants reported unforeseen challenges in completing paperwork and securing benefits. | â—Ź SCT, Outcome Expectations, Reciprocal Determinism | |
â—Ź Social networks had unanticipated positive role in HIV management (e.g., transportation to appointments, medication reminders, help completing paperwork and securing benefits. | â—Ź SCT, Reciprocal Determinism, Self-Regulation/Enlistment of Social Support | ||
â—Ź Newly diagnosed participants were hesitant to access medical care following release due to fears of HIV disclosure. | â—Ź Participants continued to be concerned about disclosure, some accessed HIV-related medical care, others did not. | â—Ź SCT, Outcome Expectations HSF, Anticipated Stigma | |
Stigma | â—Ź Participants recounted numerous counts of experienced HIV-related stigma including losing jobs, rejection by family and friends, public disclosure and harassment which occurred both prior to and during their current incarceration. | â—Ź Participants recounted numerous counts of experienced HIV-related stigma and additional stigma associated with criminal history, including losing jobs, rejection by family and friends, public disclosure, and harassment. | â—Ź HSF, Enacted Stigma |
â—Ź Participants rejected HIV-related services due to fears of HIV disclosure. | â—Ź Participants continued to avoid HIV-related services due to fears of HIV disclosure. | â—Ź HSF, Anticipated Stigma SCT, Outcome Expectations | |
â—Ź Participants expressed shame and embarrassment about their HIV status. | â—Ź Participants expressed shame and embarrassment about their HIV status and/or their substance misuse relapse. | â—Ź HSF, Internalized Stigma SCT, Outcome Expectations | |